Surgery After BRAF-Directed Therapy Is Associated with Improved Survival in BRAF V600E Mutant Anaplastic Thyroid Cancer: A Single-Center Retrospective Cohort Study
Authors' conclusion
We observed that neoadjuvant BRAF-directed therapy reduced extent of surgery and surgical morbidity. While acknowledging potential selection bias, the 12-month OS rate appeared higher in patients who had BRAF-directed therapy followed by surgery as compared with BRAF-directed therapy without surgery; yet, it was not significantly different from surgery followed by BRAF-directed therapy. PFS appeared higher in patients treated with neoadjuvant BRAF-directed therapy relative to patients in the other groups.
Study context
- Population
- Patients with BRAFV600E-mutated anaplastic thyroid cancer (ATC) and ≥1 month of BRAF-directed therapy, tertiary cancer center in Texas, 2017–2021; stage IVB (35%) or IVC (65%)
- Participants
- 57 consecutive patients
- Exposure
- Neoadjuvant BRAF-directed therapy followed by surgery vs surgery before BRAF-directed therapy vs no surgery after BRAF-directed therapy
- Neoadjuvant BRAF therapy + surgeryn = 32
- Surgery before BRAF therapyn = 12
- No surgeryn = 13
- Outcome
- OS and PFS
- Follow-up
- 12 months
Methodological detailssingle-center, consecutive patients
- Single-center
- Consecutive patients
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | Neoadjuvant BRAF therapy + surgery | Surgery before BRAF therapy | No surgery |
|---|---|---|---|
| 12-month PFS (co-primary) | 84.4% (CI 71.8–96.7) | 50% (CI 21.7–78.3) | 15.4% (CI 0–35.0) |
- 12-month overall survival (OS) and progression-free survival (PFS) by residual ATC in surgical specimen (subgroup): Residual ATC OS 83.3% [CI 62.6-100] · PFS 61.5% [CI 35.1-88]
- 12-month OS and PFS by residual ATC in surgical specimen (subgroup): Pathologic complete response OS 100% · PFS 100%
Surgical outcomes
- Neoadjuvant BRAF-directed therapy reduced tumor size, extent of surgery, and surgical morbidity score
12-month OS and PFS by residual ATC in surgical specimen (subgroup)
- Any residual ATC associated with significantly worse 12-month OS and PFS vs pathologic complete response
Original publication
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